Provider Demographics
NPI:1497153936
Name:BEN MANESH DDS VI PC
Entity Type:Organization
Organization Name:BEN MANESH DDS VI PC
Other - Org Name:IMPLANTS AND COSMETIC DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANESH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-972-4400
Mailing Address - Street 1:20528 BOLAND FARM RD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-4021
Mailing Address - Country:US
Mailing Address - Phone:301-972-4400
Mailing Address - Fax:
Practice Address - Street 1:20528 BOLAND FARM RD
Practice Address - Street 2:SUITE 212
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-4021
Practice Address - Country:US
Practice Address - Phone:301-972-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11469122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty